Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 3728545 | SC |
NPI | 1003086224 |
---|---|
Provider Name | Adam M Clark |
First Address | Charleston, SC 29407-5306 |
Second Address | Charleston, SC 29407-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2008 |
Last Update Date | 04/03/2008 |